In this proposal we outline a multidisciplinary educational intervention for staff, patients, and families of pediatric cancer patients which focuses on reducing pain and distress during medical procedures. The specific aims of the Analgesia Protocol for Procedures in Oncology (APPO) are to: (1). develop an integrated pharmacological/psychological protocol for procedures, following the recommendations of the Consensus Conference on the Management of Pain in Childhood Cancer; (2). expand education and interventions for families in assessing and coping with procedural pain and distress; (3). prepare and implement programs and materials for multidisciplinary education and involvement in pain management; (4). use quantitative methods to demonstrate the effectiveness of the protocol for staff, patients, and families, including research looking at the ways in which such programs can be implemented; and (5). disseminate the results of our work to staff, patients, and families, including hosting conferences on the use of the protocol and means of introducing APPO in other hospital and clinic settings. New pharmacological guidelines will be utilized for all patients. The APPO intervention (new guidelines plus family assessment and specialized intervention) will be introduced initially to all new patients with leukemia at The Children's Hospital of Philadelphia (N=48/year. Patients will be randomized to APPO (with an individualized psychological intervention plan) or the existing psychosocial services for the first year. In Years 2 and 3 all patients with leukemia and other pediatric cancers will be offered APPO. Multidisciplinary staff education will begin before the initiation of APPO, and continue over the three year period.